NPIMap

Organization Active NPI

Keener Civil Township Jasper County Ttee

  • Land Ambulance
  • Demotte, IN
National Provider Identifier
1215960463
Registry record updated Aug 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Land AmbulanceTaxonomy code 3416L0300X
License
0034 Issued in IN
Legal business name
KEENER CIVIL TOWNSHIP JASPER COUNTY TTEE
Practice address
708 15TH St SE
Demotte, IN 46310
Phone
(219) 987-2021
NPI assigned
Jul 9, 2006
Last updated
Aug 30, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Diana Marie Haberlin
Title
Keener Township Trustee
Phone
(219) 987-7825

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Land Ambulance 3416L0300X 0034 IN Primary

Addresses

Primary practice location

708 15TH St SE
Demotte, IN 46310

Mailing address

16900 N US Highway 231
Demotte, IN 46310-8369
Phone (219) 987-7825

Other identifiers 2

IdentifierTypeStateIssuer
20024750MedicaidIN
000000191760OtherINATHEM

Other names 1

  • Keener Township Ambulance/ EMS Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031210000086 IN Part B Supplier - Ambulance Service Supplier 4082510185 Practice locations: Demotte, IN

National Provider Directory

National Provider Directory

Locations

321 15th St SE
Demotte, IN 46310
Phone (219) 987-2021

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1535587200000",
    "number": "1215960463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16900 N US HIGHWAY 231",
            "city": "DEMOTTE",
            "state": "IN",
            "postal_code": "463108369",
            "telephone_number": "219-987-7825",
            "fax_number": "219-987-7826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "708 15TH ST SE",
            "city": "DEMOTTE",
            "state": "IN",
            "postal_code": "46310",
            "telephone_number": "219-987-2021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEENER CIVIL TOWNSHIP JASPER COUNTY TTEE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-09",
        "last_updated": "2018-08-30",
        "status": "A",
        "authorized_official_last_name": "HABERLIN",
        "authorized_official_first_name": "DIANA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "KEENER TOWNSHIP TRUSTEE",
        "authorized_official_telephone_number": "219-987-7825",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "IN",
            "license": "0034",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20024750",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ATHEM",
            "identifier": "000000191760",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Keener Township Ambulance/ EMS",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Keener Township Ambulance/ EMS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Demotte, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.